Health and Indigenous Affairs Correspondent

A HIGH-LEVEL suggestion that women should start screening for pap smears later in life and have them less often has raised concerns among cervical cancer advocates that lives could be put at risk.

A paper prepared by the government's medical advisory body for the review of the screening program raises the option of delaying the first pap smear from the current recommendation of between 18 and 20 years to 25.

The paper by the Medical Services Advisory Committee also considers reducing the frequency of pap smears from every two years to every three years, as is the practice in New Zealand and Britain.

The International Agency for Research on Cancer recommends screening every three years from ages 25 to 49 and then every five years from ages 50 to 65.

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The paper says many countries had followed the agency's recommendations and had cervical cancer incidence and mortality rates comparable to those in Australia.

But Australian Cervical Cancer Foundation chief executive Joe Tooma said he would be concerned if quality was compromised to save money. ''We want to make sure it's a better system, not just a cheaper system,'' he said.

''What if you're the one woman who doesn't get screened and dies of cervical cancer at the age of 23 or 24? I'm concerned that there could be someone who slips through the cracks. For the sake of a couple of dollars we don't want to put a price on a woman's life in a country that really should have a world class health system.''

But Karen Canfell, an associate professor at the Lowy Cancer Research Centre at the University of NSW and an adviser to Cancer Council Australia, said international evidence had shown screening women more frequently than every three years delivered ''only very marginal benefits''. Professor Canfell said screening in women younger than 25 could lead to the identification of abnormalities that might regress naturally.

But treating such abnormalities carried a risk of child-bearing complications. She said Australia had already seen a rapid drop in high-grade pre-cancerous abnormalities since vaccination against human papillomavirus - which causes cervical cancer - was introduced in 2007.

''Assuming we can keep our coverage rates up for HPV vaccination, these younger groups coming through will be at much lower risk,'' she said.

But she stressed that vaccination and screening needed to work together, and the review needed to examine whether overseas evidence was applicable to Australia.

Another option considered is allowing women to collect a sample of their own cells, for example using a tampon or cotton-tipped swab, and sending it to a laboratory for HPV DNA testing.

Professor Canfell said overseas evidence had shown while testing using self-collected samples could be less sensitive than those collected by medical professionals, making the option available increased rates of screening.

A report released last year by the Australian Institute of Health and Welfare showed screening rates had dropped for the first time in a decade, and 43 per cent of women were not getting a regular pap smear.

A spokesman for federal Health Minister Tanya Plibersek said since the screening program was introduced in 1991 ''there is a greater depth of knowledge and understanding of cervical cancer, new technologies have been developed and new international evidence has emerged''.

He said the review was an ''expert, evidence-based, consultative process'' which would consider all options.

''The best interests of Australian women will be put first and foremost in the decision-making process,'' the spokesman said. The review is expected to be completed mid-2014.

Cervical cancer is the 13th most common cancer affecting Australian women. Since 1991, the incidence of cervical cancer among Australian women aged 20 to 69 has dropped from 17.2 new cases per 100,000 women to 9.3.